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<br /> ZONING PERMIT APPLICATION www.countyofdane.colil� su '«MiNT, eoweb:app
<br /> ROP >OWNER`INFO M � � ..._;��- _�_ ,� � � �. ��,� M1-.�
<br /> OWNER NAM - N � ` ' �°." � a i ' } r NN CUSTOMER TO PROVIDE •
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<br /> OWNER ADDRESS (Numbe,Street,City...State,Zip �� Zoning Status; CUP; —I
<br /> 1 q! /2 to /c--r ZJ - po Deed Restriction; CSM
<br /> 17 ��• Variance(# )
<br /> HOME PHONE CEL PHONE E-MAILAD R
<br /> 6 or 3 y�-437 . c I ]�
<br /> -�..�.--.. WOW .�,�.,,�� � r` �)t 1 � � �0� 'C� �� Site Plan drawn to scale ■
<br /> AGENTClINFORMATIiiird-M4 5 dblifh CTO 1 iikiiiiiilail and includes dimensions 4
<br /> AGEN NAME- CONT CTOR NAME co
<br /> "`"� I _ le 'P� Sit- ' •ing location '
<br /> AGENTADDRESS CONTRACTOR ADDRESS 7 71? k if--�. ' k ) • O/O Sc .D., •
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<br /> (City,State,Zip) (City,State,Zip) 6 3/5.e ' //0
<br /> I - ' ` S, J Gu\ c s-3'_,o 6 r Setbacks
<br /> PHONE PHONE % Site Plan approval from
<br /> 6 -39C-03?-7 6. 6F 5--Q y-Z - applicable township. 4
<br /> E-MAILA••R S E-MAI AN I' SS n- A
<br /> �_ " 1_�'�1 .��,0 L-.r�J , ,/ 1 h Cr a at kh h 1.f OW Floor plans to scale
<br /> ;P(OP 101.14_ 010N 1 FO_ " 0%1 iOMrr h ' f`'�"' `'i''A' AM Y4.�-.. . ._ ���..R�� ( ttpa/access�ane.coidane.w��us/)�,j�,_,=.�,zas.� rfi -evation of property
<br /> PARENT PARCEL NU BER: .- CURRENT ZONING: ACREAGE: �1,
<br /> PARCEL �^ n •• .•e drawn to scale.
<br /> TOWNSHIP ER Y J r I�0 v����/Q ...0 ^ 4 r
<br /> SECTION:
<br /> „S% u Ljcli-, 2 6 ,/: S %IA: S. 0 Driveway permits
<br /> ADDRESS:/,-C — - - -- Ounty, town)
<br /> l\ © ( a ed oP t Sanita is
<br /> csM: a 3 O LOT SUBDIVISION U — . BLOCK/LOT (public, rivate
<br /> PROPOSED_PROJECT INFORMATION : .' a-t,_.. SYT�,� R_E�'ilk
<br /> PROJECT DESCRIPTION ,) Q T-> i _ate--� '.
<br /> J ��-( , ? CV rO✓� go e�( c e.4IC. 4 -o_raa; his roc s
<br /> This project is a new building or structure. CCU.i- Y�.pD V' t- o ." '_- 3
<br /> This project is an addition/alteration to an existing building or structure. w -- --
<br /> SANITARY SERVICE PERMI UMBER: '' •• , - - ti,
<br /> HEIGHT IN F 1 NUMBER OF STORIES: (Not including base ent) T -tr - -�F '
<br /> 3 i1. /Z. - � S' 'T p } ( r3= •��O.QSd ltl
<br /> AREA TO NEAREST SQUARE FOOT w'; l
<br /> (Outside dimensions including unfinished area, attached garages and above grade decks or porches) .-r= _
<br /> BASEMENT; , = - 1STFL•O:•� .-.. D ] - t,
<br /> O7 -
<br /> , ;,,,i i1 y3ec 4, TOTAL SQUARE FOOTAGE: 4, -,W-4 R13pe �(5 i !- pLo''_ '3 /
<br /> 2ND FLOOR: „�y ' j1' °t4-.00'G'S,''°� r :i /
<br /> 3RD t_ a ,,� � ,.- ;
<br /> .e7 - 7703 _ , - ,, /,
<br /> F,Yevie c�sa to -./
<br /> ESTIMATED CONSTRUCTION COST: J�—wry _
<br /> "', ...� "� ♦ "", ...� —U 13 Fie E e 6 P
<br /> (Please round to nearest dollar) $ 3 0 D� o 0 0 00 ,:
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake'? Oyes ' ONo.• fDon't-know
<br /> 2. Is there a wetland or floodplain on or near the property? Eyes ONo .['Don't know _
<br /> 3. Have you talked with the township about your project and are they in agreement'? QYes ONo. _ '.
<br /> 4. Has.there been a zoning permit issued for this property in the past 5 years? ElveS • ONO • '- -
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) - - _\[Yes ONo ODon't know
<br /> 7. Is this to correct a violation? pies ONo
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<br /> W APPLICATION MUST BE
<br /> SIGNED
<br /> 545112 aroa) - - • (Continue on Back) –► –► –*
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